Ending the silence about suicide

A 16-year-old's death last month -- in a state where the threat to young people is especially alarming -- has loved ones and other Mainers calling for a greater willingness to talk about mental illness, depression and pain.

SHAPLEIGH – In the weeks since Haley Plaisted committed suicide, her family and friends have struggled to understand why the vibrant girl they knew wanted to end her life.

As they flip through photos of Plaisted with her arms around her sisters and riding on a dirt bike, they question if they could have done more to help her through the depression she rarely wanted to talk about. They wonder if bullying pushed her to the point she wanted to die, or if a breakup with her boyfriend was more than she could bear.

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Shapleigh resident Rebecca Liberty struggles with her emotions recently as she holds a picture of her daughter Haley Plaisted, who took her own life April 8. John Patriquin / Staff Photographer

Haley Plaisted’s mother, Rebecca Liberty of Shapleigh, accompanied by her boyfriend, David Pillsbury, watches as balloons rise in tribute to the daughter she lost early last month. Liberty is holding a portrait of Haley that was created by the teen’s classmates at Sanford High School. Derek Davis / Staff Photographer

Family members and friends of Haley Plaisted release balloons on her 17th birthday, three days after her suicide last month, near a friend’s house in Springvale. Loved ones are still struggling to find answers for why she chose to end her life. Derek Davis / Staff Photographer

They have found no simple answers, a common situation facing those dealing with the complexities of suicide.

“I don’t know how she got to that point,” Plaisted’s mother, Rebecca Liberty, said as she sat in her kitchen looking at photos of her youngest daughter. “She wasn’t in her right mind. That child did not want to die.”

Plaisted took her own life on April 8, three days before her 17th birthday. It was a shock to her family — they say she never said she was thinking about suicide — but followed two years where Plaisted struggled with depression, bullying and a tumultuous relationship. She tried to kill herself for the first time in early 2012.

As emotional stories about teens who died by suicide grab headlines across the country, experts say people are starting to realize that communities need to have open conversations about suicide without fear it will prompt more people to take their own lives. Those conversations are particularly relevant in Maine, which has the highest rate of youth suicide in the Northeast.

At least three teens have committed suicide in Maine this year, prompting both anti-suicide and anti-bullying vigils and educational sessions for students, teachers and administrators grappling with how to deal with the shock and grief that follow suicide deaths. Gov. Paul LePage recently signed a law that requires the Department of Education to adopt standards for suicide prevention and education training in schools.

But while it is important to talk about suicide causes and prevention, experts say much of the recent media coverage that blames suicide solely on bullying oversimplifies an issue that is far more complex.

“The bullying discussion has had an effect on bringing suicide out into a more open place where it can be talked about,” said Ann Haas, senior director of education and prevention for the American Foundation of Suicide Prevention. However, she said, “I think much of the discussion has not been helpful because it has created a narrative in the public mind that youth suicide is a byproduct of bullying.”

Maine has a higher rate of youth suicide than the national average and the highest rate in the Northeast, according to the Centers for Disease Control and Prevention.

From 2005 to 2009, there were 901 suicides in Maine, of which 93 were committed by people younger than 24. Suicide is the second leading cause of death among Mainers ages 15 to 34. On average, there is one suicide every two days in Maine.

Greg Marley, who oversees the Maine Suicide Prevention Program, said youth suicide rates peaked in the late 1990s, after a decades-long increase. After the peak, suicide rates remained relatively flat until around 2005, when rates in both Maine and across the country started to rise again.

Marley said it is hard to determine why there has been an increase across the country, but said rural states like Maine generally have higher suicide rates than urban areas. That is because people tend to be more isolated from social support and professional intervention, have easier access to guns and live in a culture where fewer people seek treatment for mental illness, he said.

In recent months, youth suicide in Maine and across the country has become more public as families speak out about teens they say committed suicide because of bullying or after forced sexual encounters. While those external factors can contribute to feelings of depression or hopelessness, experts say the cause of suicide is often more complex than the headlines reveal and that addressing the issue can be both delicate and challenging.

“We work hard to dispel the notion that suicide happens because of bad life events,” Haas said. “Depression across all age groups is really the single largest underlying cause of suicide.”

Research shows that 90 percent of those who commit suicide have a mental illness or substance abuse issue, Haas said.

While the reasons people kill themselves can be complex and hard to understand, so too are the conversations about suicide that need to happen to prevent more deaths, experts say. Haas said the stigma of talking about suicide is slowly dissipating, but it’s still an issue that isn’t discussed enough.

“When you’re talking about suicide, it opens the door to allow someone to talk about the stress they’re feeling,” Marley said. “If it’s shameful or looked at as being negative, people hide it in the closet.”

Haley Plaisted’s family and friends know they cannot undo what she did, but they hope to bring more attention to suicide prevention and bullying by talking about her. Her cousin, Craig Bartlett, organized a vigil at a Sanford park to try to start a conversation in the community about how to prevent suicide. That type of action has come as a comfort to some of Plaisted’s friends.

“I hope people realize suicide should never be an option,” said Kailie Page, a friend. “Everyone has something to live for.”

‘SHE LIT UP THE WORLD’

Those closest to Plaisted remember her as an upbeat, fun and intensely loyal friend who was always trying to make people laugh. She grew up in rural York County, the daughter of Rebecca Liberty and Shane Plaisted.

One minute she’d be racing through the neighborhood on a dirt bike and the next she’d be dressing herself up in girly clothes. She was always trying to help other people and make them happy, but sometimes her good intentions were misunderstood, her family said.

“She just wanted to be going, going, going,” Liberty said of her daughter. “She was something else.”

While she often put on a happy front, Plaisted had been struggling with depression and bullying in the past few years, her mother said. She occasionally told her family she was feeling depressed, but never really wanted to talk about it. By 15, she was taking mood stabilizers prescribed to help her deal with depression.

After a physical encounter with a girl who threatened her at Massabesic High School, Plaisted transferred to Sanford, Liberty said. She was also bullied there and withdrew from school earlier this year to get away from it, Liberty said.

A little more than a year ago, Plaisted attempted suicide. The attempt came months after her mother’s husband died of cancer and Haley broke up with a serious boyfriend. She stayed briefly at Spring Harbor and moved out of state for a time to stay with her older sister. Her family thought a fresh start would be good for Plaisted, but she never wanted to be far away from her mother and friends.

Whenever her daughter was upset, Liberty said she would try to talk to her about it.

“She would clam up. She was thinking pills were going to make her feel better,” Liberty said. “She never wanted people to help her.”

Instead, Liberty said, Plaisted seemed focused on finding love and creating a family of her own.

“Haley was looking for love. When she loved somebody, she didn’t love them just a tiny bit, she loved them tons and tons and tons,” she said. “She didn’t know so many people loved her so much. It was like she couldn’t believe someone did love her that much.”

Plaisted’s friends would sometimes catch a glimpse of her stress and anxiety, but more often she was singing goofy songs or looking for an adventure.

“She lit up the world in a way nobody else could,” said family friend Jayde Burgess. “But she had a lot of pain most people couldn’t deal with for that long.”

Page, the 14-year-old friend from Sanford, grew up with Plaisted but said her friend never opened up about depression.

“I knew she had a lot of pain, but she never came to me. I couldn’t help her,” Page said moments after releasing balloons into the air on the day Plaisted would have turned 17. “She really was a lost person.”

At the balloon release, Liberty clutched a portrait of her daughter as she watched butterfly balloons disappear into the sky. After, family and friends huddled together to talk about Plaisted, their stories punctuated by both laughter and tears.

Alan Cyr, whom Plaisted considered to be her stepfather even though he and her mother divorced years ago, said she seemed to transform from a happy kid to a troubled teenager, but it was tough to tell if she was just rebelling or if something deeper was going on. She started keeping more of a distance from her family — especially her parents — and would take off from home to avoid fighting with her mom about drinking and swearing.

Cyr said Plaisted seemed to be searching for acceptance from everyone around her.

“It was like taking a square peg and putting her in a round hole. She wasn’t going to fit into the round hole the world wanted her to,” he said. “She was trying really hard to reach this level of acceptance I didn’t think she was going to get from people.”

In the weeks before she died, Plaisted was couch-surfing at friends’ houses. Her mother received only the occasional text from Plaisted and had no idea if her daughter was taking her medication properly or at all.

“She was bouncing around. She was so confused,” Liberty said. “She wanted to be an adult and make her own life.”

In those weeks, Plaisted posted frequently on her Facebook page, sometimes about drinking and drug use. Her posts show a range of emotion, from excitement about her birthday and hanging out with friends to sadness about the breakup of her relationship. Her friends say photos Plaisted posted of herself in a bikini prompted taunts from peers who often picked on her.

“Sooner or later I’m not gonna have a heart cause it’s been hurt so much it won’t be able to be put together,” Plaisted wrote in one Facebook post.

After weeks away, Plaisted finally came home on a Sunday night.

Her older sister was in town and Plaisted wanted to see her young niece. Plaisted’s family knew she had just broken up with the boyfriend she thought she would marry. But they didn’t suspect she was considering suicide.

Liberty said her daughter’s face was puffy from crying, but she brightened up when they talked about her upcoming birthday and she made plans to hang out with a friend. When her mother went to bed that night, Plaisted was exchanging text messages with her ex-boyfriend, Liberty said.

The next morning, Liberty found her daughter’s body in the garage: She had hanged herself sometime after her family went to bed for the night. The family doesn’t know if Plaisted left a note on her iPod, which was taken by police as part of the investigation.

“She was home, I didn’t think …” Liberty said, her voice trailing off as she was overcome with emotion. “I had all sorts of things I wanted to do with her. That morning I wanted to snuggle with her and talk about what to do (for her birthday). It was too late.”

Amber Killer McCormick, Plaisted’s older sister, said the family is still trying to make sense of what happened.

“We thought she was safe,” McCormick said. “She was home.”

THE FOCUS ON PREVENTION

Marley, who oversees the Maine Suicide Prevention Program, said Maine has been seen as a leader in developing training, outreach and support around youth suicide.

The prevention program was launched in 1998 when then-Gov. Angus King recognized the rate of youth suicide in Maine was significantly higher than the national average.

By 2010, the focus of the program had shifted from helping young people to preventing suicide among Mainers of all ages. Much of the work revolves around providing education and training programs in schools and to groups of adults.

Last week, LePage signed L.D. 609, a bipartisan bill to increase suicide awareness and prevention in public schools.

The bill requires the Department of Education to adopt rules on standards for schools for prevention education and training. The training and education will include suicide prevention awareness education for all personnel.

At least two people in each school district will be required to take more advanced suicide prevention and intervention training. LePage pledged $44,000 from his contingency fund to support implementation of the bill. Schools must train staff by the end of the 2015-16 school year.

“The devastating effect suicide has on Maine families and communities is real, and we must be willing to address the issue,” LePage said in a statement after signing the bill.

After a school or community experiences a suicide, the Maine Suicide Prevention Program is able to come in to provide information, resources and guidance to help people through the shock and grief. All schools are required to have a crisis team in place to deal with those types of situations, but how prepared they are to deal specifically with a suicide “varies considerably,” Marley said.

Marley said that kind of post-suicide response — or “postvention” — is helpful because it helps address immediate needs, but also lowers the risk of copycat or associated suicides. The risk of suicide contagion is most prevalent among youth and young adults.

“Good postvention is good suicide prevention,” he said.

The program’s goals now include focusing on suicide prevention among working-age adults and integrating suicide prevention into the primary health care provider setting. Marley said involving primary care doctors in suicide prevention is important because it provides an opportunity to identify people who are struggling.

“People are still reluctant, particularly adults, to reach out for anything labeled mental health help,” he said.

Haas, from the national suicide prevention group, said one of the most important aspects of suicide prevention efforts — including those in Maine — is the focus on how to recognize depression and help people who are struggling. While experts know most people who commit suicide have a mental illness such as depression, symptoms can be harder to recognize in teens than adults.

“It often isn’t the kind of sadness and teariness that most people think of with depression,” Haas said. “(Depression in youth) can be angry, oppositional behavior, drinking and other kinds of acting out.”

Teenagers with depression can be argumentative and unpleasant, which “makes it harder to keep the focus on the child and what they need because it seems like behavioral problems,” Haas said.

The American Foundation for Suicide Prevention created films about depression in teens to show at schools and to adults, which she said have been effective in starting conversations and educating people about the problem.

“We need to do a lot more educating about the role of depression. It is treatable,” Haas said. “The really difficult part about it is it doesn’t mean it always prevents suicide. It’s not a guarantee that we can get a young person on a different course, but treatment is the best course.”

Marley of the Maine Suicide Prevention Program agrees.

“The majority of young people who attempt suicide and get the help they need go on to not get back into another suicide crisis again.”

That’s why, Marley said, it’s so important to make sure “if someone is feeling suicidal or considering making an attempt on their life, they get serious intervention help to move beyond that place where their life isn’t working.”

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